Focus Group Registration

This form is for all Level 7 students participating in the CIEP Focus Group. The purpose of this form is to update your personal contact information with the CIEP. Please complete the following form to allow CIEP to stay connected with you!

* Required

First Name
*

This is a required question

Last Name
*

This is a required question

Personal Email Address
*

This is a required question

Home (Permanent) Address
*

This is a required question

Cell Phone Number

This is a required question

Focus Group Date
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Friday, August 2

Other:

This is a required question

What are your plans after you graduate from CIEP?
*

This is a required question

If you graduate from CIEP, would you be willing to participate in an alumni interview and have your profile featured on the CIEP website?
*

Yes

No

This is a required question

Briefly describe your experience at UNI, how CIEP has helped you, or a favorite memory.

*The CIEP may use the answer to this question in promotional material.